Will Biden’s mandates work? Macron’s vaccine pass gamble may hold some clues

By Eliza Mackintosh, Joseph Ataman, Saskya Vandoorne and Melissa Bell, CNN

After US President Joe Biden laid out a plan to tackle the worsening pandemic in America with a raft of new vaccination rules last week, the big question on the minds of many is: Will mandating vaccines work?

Across the Atlantic, in France, it’s a gamble that is beginning to pay off.

Despite a slow start to its vaccination rollout earlier this year, fueled by supply-chain issues that culminated in a bruising public battle with AstraZeneca over delivery shortfalls and blood clot concerns, France finally got its program up and running in the spring. By May, the country reached its goal of partially vaccinating 20 million people — 30% of its population. But then it quickly started to hit a wall.

In July, with France’s vaccination rate stagnating and coronavirus cases surging, French President Emmanuel Macron imposed sweeping vaccination requirements for much of daily life.

As of August 1, anyone without a “health pass” showing proof of their vaccination status or a recent negative test, would not be able to enter bars and cafes, or travel long distances by train, Macron said. Health care staff workers — a group of roughly 2.7 million people in France — who are not vaccinated by Wednesday, face being fired or suspended without pay.

Macron’s move was a calculated risk in a country where a deep cultural belief in individual liberties and a distrust of government has manifested in vaccine hesitancy.

Despite its history as the cradle of vaccine science — France is home to pharmaceutical giants Sanofi and the Pasteur Institute, named for Louis Pasteur, one of the founders of modern vaccination — French people have long been reluctant to embrace them. A Wellcome Global Monitor survey published in 2019 found that one in three French people disagreed that vaccines were safe — more than any other country out of 144 surveyed.

During the country’s second coronavirus lockdown in December 2020, two separate polls carried out by Paris-headquartered Ipsos and the French Institute of Public Opinion found that around 60% of French people surveyed said that if a vaccine for Covid-19 was available they would not take it.

“Clearly, Emmanuel Macron took a risk,” said Bruno Cautres, a political analyst at the Center for Political Research at Sciences Po in Paris.

“He took a risk to say I will make the life of the non-vaccinated very difficult, which is a very, very, very dangerous statement for an executive.”

As the proposal went to French lawmakers, protesters began weekly demonstrations against the health pass. On July 31, more than 200,000 people took to streets across France, a mix of those opposed to the health pass and its restrictions on freedoms, and people reluctant to get vaccinated entirely.

Yet for all the noise, many more French people were voting with their feet in support of the pass, and extending their arms. On the same day, 532,000 people were vaccinated, according to France’s health ministry.

Despite some early opposition, Macron’s risk looks to be reaping significant rewards.

Immediately following Macron’s speech on July 12, there was a spike in vaccination appointments in France. Doctolib, the main platform for booking jabs in the country, saw 1 million appointments made in 24 hours. Thanks in part to its swelling vaccination rate — along with a massive increase in testing linked to the Covid pass, and the reintroduction of mask mandates in regions badly hit by the Delta variant — mainland France managed to largely sidestep the fourth wave that swept through Europe and the US.

A month into France’s new health pass regime, data from the country’s health agency show an overall decline in hospital and ICU admissions since the summer highs. And while public health experts are waiting to see if the decline will continue, many are cautiously optimistic.

“In the few minutes after the [Macron’s] announcement, there was a record hit in the number of reservations to vaccinate. And this continued also on the following days. And what we see now is that they’re still increasing,” Vittoria Colliza, a Paris-based epidemiologist at Inserm, the French public-health research center, told CNN in a phone interview in August.

“I think that in terms of incentives, this is really working. And the sanitary pass itself also has a second effect … the limiting of contact risk in our social daily life, so this should have an effect in terms of the number of cases.”

Today, France’s Covid-19 vaccination rate is among the highest in the world, with 73% of people having received at least one shot, according to Our World in Data.

In the US, vaccination rates have stalled. Only 62% of the US population has had at least one dose, according to Our World in Data, and the majority of those who are not vaccinated are not at all likely to get a shot, according to Axios-Ipsos polling.

Now the US is looking to replicate some of France’s success.

Last Thursday, President Biden imposed stringent new vaccine rules on most federal workers, health care staff and companies with 100 or more employees. Announcing the move, which could affect as many as 100 million Americans, Biden expressed frustration at the unvaccinated. “We’ve been patient, but our patience is wearing thin, and your refusal has cost all of us,” he said, acknowledging the new steps would not provide a quick fix.

The mandates represent a significant change in tack for the Biden administration, which previously tried to avoid widespread vaccine requirements. In the US, mask and vaccine mandates have predominantly been left to local authorities. But, as US vaccination efforts stagnated in recent months, the administration began to pivot to more coercive measures to get shots in arms. In late July, Biden announced that all federal employees and contractors would be required to get vaccinated, or submit to regular testing.

While some employers and labor unions have voiced their support for the new rules, many Republican leaders have said they will challenge the requirements for large employers to mandate vaccinations in court.

Other critics of Biden’s vaccine mandates argue that they will only “harden the resistance” among people already reluctant to get a shot.

Heidi Larson, the founder of the Vaccine Confidence Project, agrees that government coercion isn’t necessarily a silver bullet for converting the unvaccinated.

“At the end of the day, it [mandates] does increase uptake, but for those people who are hesitant, things like that make them even more angry. They dig their heels even deeper,” Larson said.

“We did some national research with a lot of people in the UK, and brought in the whole vaccine passport question, and it was fine for the people who were pro-vaccine and accepted them, but for the people who were hesitant, it made them even more hesitant, and more likely to refuse if they felt like they were being told they had to do it, or that it was some moral responsibility.”

Some countries, including England, have said they won’t go the vaccine passport route.

For those hesitant about receiving newly developed vaccines, broader action to encourage uptake is necessary, experts say. Information was “not very clear” about the vaccines, said Catherine Hill, an epidemiologist at the Gustave Roussy institute in Paris. “There were a lot of rumors of fake news about the trials,” she said.

Ahead of the new law, the French government tried to gear up vaccination rates through incentives and public health appeals — an effort they’ve continued as the health pass has rolled out.

In August, the presidential Elysee Palace began a social media charm offensive aimed at France’s young people. President Macron took to TikTok and Instagram, posting uncharacteristically relaxed videos, some from his holiday home, calling on French people to get vaccinated.

“Get yourselves vaccinated if you love your relatives, your friends, your brothers, your sisters and your parents,” Macron said on Instagram, “because in getting vaccinated yourselves, you are protecting them too.”

The communications rethink coincided with a push to make vaccines more readily available. Seaside appointments were opened for those on holiday and walk-in sessions began, both of which epidemiologist Hill credits for helping with France’s Covid-19 U-turn.

“This [mandates] was really a change of paradigm,” Colliza said. “If you think about vaccine hesitancy and how authorities tried to handle it, at the beginning it was really a lot of pressure on explanations, on communication, and the aim was really not to oblige people but to convince them. And at a certain point, given the very large circulation of the Delta variant in several EU countries, authorities move towards something that is a bit more constraining.”

The final phase of Macron’s health pass law kicks in this week, with the mandate on health workers coming into effect.

As of August 30, public-facing workers, as well as customers, in establishments covered by the law were required to present a health pass to enter the premises. In France, nearly 1.8 million workers fell under this extension.

Anais Majdoubi, a 27-year-old employee at an escape game business in Paris, was initially hesitant to get vaccinated. She used to get a Covid-19 test every three days to show to her boss, a strategy that proved impractical when the French government approved the health pass law in August. She reluctantly got the jab, but fears for what it means for those still holding out against vaccination.

“I think we just have to be careful about people who are not vaccinated, not to treat them any different,” Majdoubi said.

“We shouldn’t be pointing our fingers at them.”

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CNN’s Eliza Mackintosh wrote and reported from London, England, and Joseph Ataman, Saskya Vandoorne and Melissa Bell from Paris, France.